Differential Diagnosis for the Hepatic Lesion
- Single most likely diagnosis
- Focal Nodular Hyperplasia (FNH): The presence of a central T2 hyperintense scar with delayed phase enhancement is highly suggestive of FNH. The lesion's characteristics, such as being T1 hypointense, mildly T2 hyperintense, and arterially hyperenhancing before becoming isointense to the liver parenchyma, are also consistent with FNH.
- Other Likely diagnoses
- Hepatocellular Adenoma (HCA): Although less likely than FNH due to the specific imaging features, HCA can present with similar characteristics, including arterial hyperenhancement and a variable appearance on T1 and T2-weighted images. However, the central scar is more typical of FNH.
- Inflammatory Hepatocellular Adenoma: A subtype of HCA, which might show a central scar and could have a similar appearance to FNH on imaging, though it's less common.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hepatocellular Carcinoma (HCC): Although the imaging features are not typical for HCC, especially the presence of a central scar, it's crucial to consider HCC in any liver lesion, especially in patients with risk factors like cirrhosis or chronic hepatitis. Missing HCC could have significant implications for patient outcomes.
- Metastasis: While the description doesn't strongly suggest metastasis, any liver lesion could potentially be a metastasis, especially in patients with a known primary malignancy. The consequences of missing a metastatic lesion could be severe.
- Rare diagnoses
- Fibrolamellar Carcinoma: A rare subtype of HCC that can present with a central scar and might show similar imaging characteristics. It's more common in younger patients without underlying liver disease.
- Biliary Hamartoma (Von Meyenburg Complex): Typically smaller and multiple, but could be considered in the differential for a liver lesion with a central scar, though it's much less likely given the size and description provided.
- Hepatic Angiomyolipoma: A rare benign tumor that could have variable imaging appearances, including being T1 hypointense and T2 hyperintense, but it's less likely given the specific features described, such as the central scar.